Construction of a Vero Cell Line Expressing Human ICAM1 for the Development of Rhinovirus Vaccines

Human rhinoviruses (HRVs) are small non-enveloped RNA viruses that belong to the Enterovirus genus within the Picornaviridae family and are known for causing the common cold. Though symptoms are generally mild in healthy individuals, the economic burden associated with HRV infection is significant. A vaccine could prevent disease. The Vero-cell-based viral vaccine platform technology was considered for such vaccine development. Unfortunately, most HRV strains are unable to propagate on Vero cells due to a lack of the major receptor of HRV group A and B, intercellular adhesion molecule (ICAM1, also known as CD54). Therefore, stable human ICAM1 expressing Vero cell clones were generated by transfecting the ICAM1 gene in Vero cells and selecting clones that overexpressed ICAM1 on the cell surface. Cell banks were made and expression of ICAM1 was stable for at least 30 passages. The Vero_ICAM1 cells and parental Vero cells were infected with four HRV prototypes, B14, A16, B37 and A57. Replication of all four viruses was detected in Vero_ICAM1, but not in the parental Vero cells. Altogether, Vero cells expressing ICAM1 could efficiently propagate the tested HRV strains. Therefore, ICAM1-expressing cells could be a useful tool for the development and future production of polyvalent HRV vaccines or other viruses that use ICAM1 as a receptor.

A Case Report on Sphenoidal Sinusitis with Brain Abscess in a 16 Year Old

A pyogenic infection-induced brain abscess is rare, and usually affects immunocompromised people. Brain imaging and bacterial culture from the infection site are used to diagnose a brain abscess. An effective treatment method is surgical resection combined with antibiotic treatment with bacteria-sensitive antibiotics for a sufficient period of time. Presentation of the Case: A 16-year-old boy was confirmed to have Sphenoidal Sinusitis. The patient had been diagnosed with dengue fever three weeks ago and corona infection four months ago. And finally, he was diagnosed with Sphenoidal Sinusitis which manifested as severe headache, vomiting, and fever. He underwent bilateral Functional Endoscopy Sinus Surgery (FESS), sphenoidotomy and also temporal craniotomy and evacuation of abscess. Conclusion: The treatment of a brain abscess requires early diagnosis, appropriate surgical treatment, and adequate duration of therapy with effective antibiotics.

Endometriosis: Aetiopathogenetic Basis

Endometriosis, defined by the presence of endometrial tissue outside the uterine cavity, is a common condition affecting 10% of women in the reproductive age. Menstrual factors reported to increase risk include dysmenorrhea, early menarche, and shorter cycle lengths. The theory of retrograde menstruation with implantation of endometrial fragments, in conjunction with peritoneal factors to stimulate cell growth is the most widely accepted.

There is a growing body of evidence that immunological factors and angiogenesis play a key role in the pathogenesis of endometriosis. In women with endometriosis, there appears to be an alteration in the function of peritoneal macrophages, natural killer cells and lymphocytes, with production of growth factors and inflammatory mediators in the peritoneal fluid. Survival, adhesion, proliferation, invasion and vascularization of endometrial tissue in abdominal cavity may be the consequence of retrograde menstruation and referred to as implantation theory.

Carcinoma dei Dotti Collettori del Bellini: Case Report con Metastasi Cutanea Come Iniziale Manifestazione Clinica

Introduction

Bellini's collecting ducts carcinoma represents a rare tumor with an aggressive behaviour with a poor prognosis and often metastatic at diagnosis. We report the first case documented of Bellini tumor with an initial clinic presentation represented by a cutaneous metastasis of scalp.

Materials and Methods

All pertinent clinical information were compiled, including patient age, sex, mode of presentation, preoperative laboratory data, radiologic findings, surgery type, macro and microscopic findings, survival data.

Results

After reporting an histopathologic finding of cutaneous metastasis of unknown origin adenocarcinoma with poorly differentiation, a voluminous 6 cm left mesorenal mass is diagnosed through uro-CT. Consequently, it is performed a left radical transperitoneal nephrectomy with consensual exeresis of scalp cutaneous lozenge at the level of previous excision. The histopathologic diagnosis reported was Bellini tumor at stage pT3a-N2-M1. It has not reported significative responsiveness to adjuvant chemotherapy and the patient was died seven months after diagnosis of cutaneous metastasis.

Conclusions

Most of Bellini's carcinoma are already metastatic at presentation. Analiyzing literature, it is never documented a cutaneous metastasis as first sign at clinical presentation. In this context, radical nephrectomy, differently from others subtypes of advanced renal cell carcinoma, does not seem to improve survival of the patient but rather, it can keep a role in palliation or in the context of new chemotherapeutic protocols.

[Endometriosis: aetiopathogenetic basis]

Endometriosis, defined by the presence of endometrial tissue outside the uterine cavity, is a common condition affecting 10% of women in the reproductive age. Menstrual factors reported to increase risk include dysmenorrhea, early menarche, and shorter cycle lengths. The theory of retrograde menstruation with implantation of endometrial fragments, in conjunction with peritoneal factors to stimulate cell growth is the most widely accepted. There is a growing body of evidence that immunological factors and angiogenesis play a key role in the pathogenesis of endometriosis. In women with endometriosis, there appears to be an alteration in the function of peritoneal macrophages, natural killer cells and lymphocytes, with production of growth factors and inflammatory mediators in the peritoneal fluid. Survival, adhesion, proliferation, invasion and vascularization of endometrial tissue in abdominal cavity may be the consequence of retrograde menstruation and referred to as implantation theory.

[Calciphylaxis and penile necrosis: a case report and review of the literature ]

INTRODUCTION

Calciphylaxis is a rare clinic condition characterised by skin necrosis due to medial and intimal calcification of small and medium arteries. It's observed in patients affected by end stage renal disease associated to secondary hyperparathyroidism. Penile involvement has been documented in very few cases. We present both a case of penile calciphylaxis and a review of literature, in order to increase comprehension of pathophysiology, diagnosis and therapy of this rare disease.

MATERIALS AND METHODS

A retrospective review of literature was performed after treating a case of penile calciphylaxis. We describe patient characteristics, clinical presentation, laboratory and histo-pathologic findings, therapeutic strategy and outcomes of the case.

RESULTS

A 65 year-old man, affected by diabetes, chronic ischemic cardiopathy and chronic renal failure in hemodialytic treatment, was referred to our unit for the presence of increased consistency and significative pain of the distal portion of penis evolving in a complete glans necrosis. Blood levels of parathormone (PTH), calcium (Ca) and phosphorous (P) resulted pathologically elevated, promoting tissutal calcium deposition. The patient was treated with partial penectomy and the histologic findings confirm diagnosis of calciphylaxis, showing an ulcerative necrosis of glans with extensive calcium deposition and luminal narrowing of penile small arteries.

CONCLUSIONS

The increase of number of patients with chronic renal failure in hemodialytic treatment could make penile calciphylaxis more prevalent in the future. Early diagnosis, lowering of pathologic blood levels of Ca and P associated to surgical treatment of necrotic lesions of the patient could be fundamental for a better prognosis of this aggressive disease.

[Carcinoma of the collecting ducts of Bellini: a case report with cutaneous metastasis as the initial clinical manifestation]

INTRODUCTION

Bellini's collecting ducts carcinoma represents a rare tumor with an aggressive behaviour with a poor prognosis and often metastatic at diagnosis. We report the first case documented of Bellini tumor with an initial clinic presentation represented by a cutaneous metastasis of scalp.

MATERIALS AND METHODS

All pertinent clinical information were compiled, including patient age, sex, mode of presentation, preoperative laboratory data, radiologic findings, surgery type, macro and microscopic findings, survival data.

RESULTS

After reporting an histopathologic finding of cutaneous metastasis of unknown origin adenocarcinoma with poorly differentiation, a voluminous 6 cm left mesorenal mass is diagnosed through uro-CT. Consequently, it is performed a left radical transperitoneal nephrectomy with consensual exeresis of scalp cutaneous lozenge at the level of previous excision. The histopathologic diagnosis reported was Bellini tumor at stage pT3a-N2-M1. It has not reported significative responsiveness to adjuvant chemotherapy and the patient was died seven months after diagnosis of cutaneous metastasis.

CONCLUSIONS

Most of Bellini’s carcinoma are already metastatic at presentation. Analyzing literature, it is never documented a cutaneous metastasis as first sign at clinical presentation. In this context, radical nephrectomy, differently from others subtypes of advanced renal cell carcinoma, does not seem to improve survival of the patient but rather, it can keep a role in palliation or in the context of new chemotherapeutic protocols.

Calcifilassi e Necrosi Peniena: Case Report e Revisione Della Letteratura

Introduction

Calciphylaxis is a rare clinic condition characterised by skin necrosis due to medial and intimal calcification of small and medium arteries. It's observed in patients affected by end stage renal disease associated to secondary hyperparathiroidism. Penile involvement has been documented in very few cases. We present both a case of penile calciphylaxis and a review of literature, in order to increase comprehension of patophysiology diagnosis and therapy of this rare disease.

Materials and Methods

A retrospective review of literature was performed after treating a case of penile calciphylaxis. We describe patient characteristics, clinical presentation, laboratory and histopathologic findings, therapeutic strategy and outcomes of the case.

Results

A 65 year-old man, affected by diabetes, chronic ischemic cardiopathy and chronic renal failure in emodialithic treatment, was referred to our unit for the presence of increased consistency and significative pain of the distal portion of penis evolving in a complete glans necrosis. Blood levels of parathormone (PTH), calcium (Ca) and phosphorous (P) resulted pathologically elevated, promoting tissutal calcium deposition. The patient was treated with partial penectomy and the histologic findings confirm diagnosis of calciphylaxis, showing an ulcerative necrosis of glans with extensive calcium deposition and luminal narrowing of penile small arteries.

Conclusions

The increase of number of patients with chronic renal failure in emodialithic treatment could make penile calciphylaxis more p\revalent in the future. Early diagnosis, lowering of pathologic blood levels of Ca and P associated to surgical treatment of necrotic lesions of the patient could be fundamental for a better prognosis of this aggressive disease.

Long-term effects of a program of bladder preservation using chemotherapy plus radiotherapy in muscle invasive bladder cancer (BC). Analysis of biologic predictive factors and health-related quality of life (QOL)

e16014

Background: Long-term effects of a combined approach of transurethral resection (TUR) plus chemotherapy (CT) and pelvic radiotherapy (RT) in terms of bladder preservation, survival, QOL are largely unknown. Moreover we investigated whether p53, Ki67, bcl-2, c-erbB-2 protein expression predict the achievement of a complete response (CR). Methods: From March 1994 to June 2000, 75 pts with muscle invasive BC were treated with a bladder sparing approach including an initial TUR, 3 cycles of CT (cisplatin + 5- FU) alternating with pelvic RT (40 Gy). At the response evaluation, pts with biopsy proven residual disease were considered incomplete responders (IR) and underwent immediate cystectomy. Pts with CR were treated with two additional CT cycles plus a bladder RT boost (20- 24 Gy). Paraffin embedded blocks of the primary tumors were collected and Ki67, p53, bcl-2 and c-erbB-2 protein expression were evaluated in a blind fashion. The Expanded Prostate Cancer Index Composite (EPIC) scores for urinary function, (especially storage, voiding symptoms and bowel function) was used to explore QOL in bladder preserved and compared with a group of matched patients treated by radical cystectomy only. Results: Median age was 67 yrs (range 42–80); T2a-T2b: 42%; T3a-T3b: 47%; T4a: 11%; G3: 88%; hydronephrosis: 32%. Overall, 56 (74.7%) pts achieved a CR and the achievement of a CR was significantly related to lower T stage (p= 0.002), high Ki67 (p=0.001), absence of hydronephrosis (p= 0.007) and high p53 overexpression (p=0.007). Multivariate analysis showed that only a low T stage (p=0.002) and high p53 expression (p=0.043) predict the obtaining of a CR. At 5 years of follow-up, 44 (59%) were alive and in 33 of them (75%) bladder was preserved; after 10-years 28 (37.3%) were alive and in 23 of them (82%) bladder was preserved. Analysis of QOL scores is ongoing. Conclusions: This approach induces a long term survival similar to radical cystectomy with a high rate of bladder preservation and represents a valid treatment for muscle invasive BC. Overexpression of p53 is a predictive marker for the obtaining of CR and for bladder preservation.

No significant financial relationships to disclose.

A Rare Case of Female Bladder Spontaneous Rupture

Bladder spontaneous rupture in the woman represents an extremely rare urologic emergency; its cause can be iatrogenic, neoplastic or diabetic.

Materials and Methods

A 56-year-old woman was referred to our unit because of the presence of acute abdominal pain, oligoanuria and vomiting for two days. At physical examination, the patient presented with confusional state, acute urinary retention and gross hematuria after urethral catheterization. Laboratory data demonstrated important metabolic abnormalities: hyperglycemia (946 mg/dL), acute renal failure (serum creatinine: 3.25 mg/dL), hyponatremia (120 mEq/L) and metabolic acidosis. At the CT of her abdomen and pelvis, a suspected bladder rupture (right lateral wall) was revealed, and confirmed after performing a retrograde cystography. Personal history was negative for trauma; glycemia was never controlled despite an important familiarity for type I diabetes. An episode of painless gross hematuria had occurred one month before, treated by the physician with antibiotics. Firstly the metabolic and electrolyte imbalance was corrected and then an emergency explorative laparotomy was performed. An important urinary leakage in the pelvis and a mild peritoneal effusion were documented. Furthermore, an important leak of papillary-like neoplastic material from the vesical breach was detected. The neoplasm seemed to involve the whole bladder. The surgical treatment consisted in bladder raphia, accurate washing of perivesical space, difficult salvage cystectomy (tenacious adhesions due to the urinary leakage) and bilateral ureterocutaneostomy. During the postoperative stay, the patient showed a difficult glycemia control with insulin therapy and wound dehiscence healed by second intention. The hospital discharge was on day 30, with the patient in good health and acceptable glycemia control.

Results

The pathological diagnosis was a G2 non-invasive urothelial carcinoma, also involving a vesical diverticulum; the neoplasm was associated with an erosive chronic cystitis with aspects of transparietal micro-abscessual flogosis (pT1 G2 N0 Mx). The patient will perform a CT scan 3 months after surgery before possibly starting chemotherapy.

Conclusions

Bladder spontaneous rupture in the woman is an extremely rare pathology; in the reviews we analyzed, it is dealt with as a clinical condition that more often occurs in patients submitted to pelvic surgery followed by adjuvant radiotherapy. Invasive bladder neoplasms, predominantly the sarcomatoid ones, are the second more frequent cause mentioned in the literature. Diabetic uropathy of the bladder associated with purulent bacterial cystitis in the elderly is the third cause, which is mentioned in two articles only. At last, only one study indicates the superficial urothelial bladder cancer (pT1- G2) as the responsible for this dramatic event. In our case, the suspected bladder diabetic uropathy, characterized by reduced perception of micturition stimulus, the increase in vesical capacity and detrusorial hypocontractility, were probably an important concomitant cause of this dramatic clinic condition, in association with the large superficial urothelial neoplasm. Moreover, diabetic neuropathy could explain the delay of patient presentation to the physician. Urinary leak, probably occurred 2 days before diagnosis, created an important metabolic imbalance and remarkable surgical difficulties. The timely treatment allowed for the resolution of a clinical condition associated with an elevated mortality due to septic shock.

Closing the diarrhoea diagnostic gap in Indian children by the application of molecular techniques

A large proportion of diarrhoeal illnesses in children in developing countries are ascribed to an unknown aetiology because the only available methods, such as microscopy and culture, have low sensitivity. This study was aimed at decreasing the diagnostic gap in diarrhoeal disease by the application of molecular techniques. Faecal samples from 158 children with and 99 children without diarrhoea in a hospital in South India were tested for enteric pathogens using conventional diagnostic methods (culture, microscopy and enzyme immunoassays) and molecular methods (six PCR-based assays). The additional use of molecular techniques increased identification to at least one aetiological agent in 76.5 % of diarrhoeal specimens, compared with 40.5 % using conventional methods. Rotavirus (43.3 %), enteropathogenic Escherichia coli (15.8 %), norovirus (15.8 %) and Cryptosporidium spp. (15.2 %) are currently the most common causes of diarrhoea in hospitalized children in Vellore, in contrast to a study conducted two decades earlier in the same hospital, where bacterial pathogens such as Shigella spp., Campylobacter spp. and enterotoxigenic E. coli were more prevalent. Molecular techniques significantly increased the detection rates of pathogens in children with diarrhoea, but a more intensive study, testing for a wider range of infectious agents and including more information on non-infectious causes of diarrhoea, is required to close the diagnostic gap in diarrhoeal disease.

Balanitis Xerotica Obliterans: Presentation of a Case

Balanitis xerotica obliterans is a term applied to a chronic inflammatory disease of the glans penis and prepuce. The symptoms are usually a sudden FIMOSI, a reduction of the sensibility of the glans, a stenosis of the uretreal meatum and dysuria. The disease was thought in the past as a rare pathology, whereas recent reviews of the literature showed that its frequency is quite high. We present a case of a male patient who presented to the urological department of the Guastalla hospital for a sclerosing lesion of the glans. The lesion were biopsied, and the histological picture showed hyperkeratosis of the epithelium with atrophy of the malpighian layer, oedema of the upper dermis and inflammatory infiltrate of medium derma (lymphocytes and scattered histyocites). The early diagnosis and the following treatment of this pathology are very important for its resolution, although the surgery is not always needful (often it is sufficient the clinical diagnosis). The surgical excision shall be used always in case of differential diagnosis with a neoplastic and/or atypical or uncertain lesions (penis carcinoma).

[Interstitial laser therapy in benign prostatic hyperplasia]

The interstitial laser therapy is a low invasivity system for prostatic benign hyperplasia. We report our experience with Indigo 830e new system where diode laser and optical temperature sensor warrant a laser-induced interstitial thermal therapy able to continuously adjust energy delivery to the tissue.

[Unusual case of inverted papilloma in a fibro-epithelial polyp of the ureter]

Inverted papilloma of the upper urinary tract is a rare lesion and the differential diagnosis with transitional cell carcinoma is really hard. A case of 49 year-old male with recurrent right flank pain is reported. Excretory urogram suggested a filling defect involving the right mid ureter and bilateral retrograde pyelogram that confirmed a solitary filling defect in the right mid-ureter, while selective urinary cytology was positive for transitional cell carcinoma G1. Conservative therapy was carried out and 2 years follow-up with several excretory urograms and ultrasound studies revealed no recurrence.

[Sertoli cell tumor. Case report]

A case of Sertoli cell tumor is described. It represents 1% of testicular neoplasms. Its clinical features, histology, histogenesis and treatment on the basis of the current literature are reported. The malignant potential of this kind of tumor is also stressed.

[Eosinophilic cystitis: an incidental diagnosis. An underdiagnosed entity]

The authors report on two cases of eosinophilic cystitis diagnosed by chance, are reported. Both patients had suffered from prostatic and vesical diseases. Since the endoscopic appearance and clinical manifestation of this disease are aspecific, the diagnosis of eosinophilic cystitis is always made on histological specimen. Even if it has been described as a rare entity, personal opinion is that the real incidence of eosinophilic cystitis is underestimated. The main features of pathogenesis and therapy are also described.

[Bilateral renal oncocytoma. A clinical case and review of the literature]

Renal oncocytoma is an epithelial tumour of the kidney, originally considered benign neoplasm, but now it is thought have a limited but real malignant or metastatic potential. Usually monolateral, in 6% of cases it is bilateral in a synchronous or metachronous way. A case of bilateral renal oncocytoma in a 56-year-old woman, observed by chance during a follow-up carried out after breast cancer is described. The etiopathogenic and clinical-therapeutic aspects of this neoplasm are examined, and the conclusion is drawn that the most correct therapeutic approach must aim at both the protection of kidney function and complete removal of the tumour.

[Value and limitations of transrectal ultrasonography and computer tomography in preoperative staging of prostate carcinoma]

A careful evaluation of local tumoral extension is mandatory in patient selected for radical surgery for prostate cancer. Nevertheless, prostatic imaging, achieved with transrectal ultrasonography (TRUS) and CT scan, is often unable to stage accurately the disease. The Authors report a retrospective analysis of 43 patients treated with radical retropublic prostatectomy: their findings support the idea that both TRUS and CT scan are unable to define the extent of the tumor, reaching respectively accuracies of 38 and 46%. From these data they conclude that CT can be excluded from the preoperatory workup of prostate cancer, except in selected patients, at high risk of nodal metastasis on the basis of PSA. TRUS is the mainstay of prostate cancer diagnosis and staging because it guides transrectal biopsies, but any conclusion made exclusively on the base of its imaging seems not reliable.

[State of the art in Nd:Yag laser treatment of benign prostatic hyperplasia]

Laser energy is widely used in medical sciences nowadays. Recently it has gained importance in urology as an alternative treatment, less invasive than conventional surgical approaches, to benign prostatic hypertrophy (BPH). The Authors present a review of the literature describing the different approaches to the laser treatment of BPH: visual laser ablation of the prostate (VLAP), TULIP, contact vaporization and interstitial laser therapy. They try to show vantages and limitations of this technique respect to conventional surgery. They also present their personal experience with VLAP. They conclude that prostate laser therapy is an alternative to TURP for patients suffering for uncomplicated BPH of small to medium volumes (< 40 ml). According to literature's data and personal experience, it seems that VLAP, the easiest technique, is able to achieve the best results.

[Intratesticular adenomatoid tumor]

A case of adenomatoid tumor of the testis is shown. Of this rare benign neoplasm a review of the literature is presented.

Nursing nel paziente urologico, anziano, operato: Nursing of the elderly urological patient

There are two important issues in the postoperative management of the urological elderly patient: complications and rehabilitation. Aging is associated with a loss of homeostatic reserve that may lead to postoperative complications due to drug interaction, malnutrition, infection, defects in wound healing, and poor psychological state. Furthermore rehabilitation, if not properly planned or implemented may influence not only the quality of life, but also the whole treatment results. The authors, in relation to pathogenetic aspects, describe what to do to prevent complications and to promote patient recovery. They conclude that both urologists and nurses must have specific geriatric training and that a psychiatrist, dietician, geriatrician and physiotherapist should be part of the team caring for the elderly surgical patient. Finally discharge from hospital must not be the end of therapy: in selected patients nursing management may continue at home reducing morbidity and mortality and helping better rehabilitation.

Alternative Mini-Invasive Nelle Ostruzioni Cervico-Uretrali Dell'anziano: La Laserterapia: Mini-Invasive Alternatives in Cervico-Urethral Obstructions in the Elderly: Laser Therapy

An ageing general population, increase in average life span and prevailing benign prostatic hypertrophy bring an increasing number of elderly men to surgery for cervico-urethral obstruction. Given the small but significant morbidity of TURP, recently new mini-invasive techniques have been introduced for BPH, laser therapy being the most popular. The authors report on the different methods for delivering laser energy to the prostate, discussing the benefits and defects. They also present their personal experience with 44 patients aged over 75 years subjected to Nd:YAG laser prostatectomy from 1992 until today. In these patients transurethral laser evaporation, as suggested by Narayan and al., produced significant symptomatic and clinical results with low morbidity and invasiveness. The authors therefore believe that this kind of therapy may improve management of the elderly patient with BPH.

A New Fibre (Quadralase) for Treating BPH with Laser ND:YAG

Laser photocoagulation, due to simplicity and good results, is the main alternative to TURP in BPH. The technical evolution of materials and procedures has favoured vaporisation of the prostate instead of simple coagulation. More energy has thus been required for the treatment, leading to fibre damage or malfunctioning and increasing cost for single treatment. We report our initial experience with the Quadralase fibre that has a specially designed distal cap, which always allows the laser beam to be transmitted through a clean surface. We believe this is a further technical improvement in prostatic vaporisation with Nd:YAG laser, which may reduce operating times and fibre damage.

[Renal lymphoma: an atypical mass in search of characterization]

We report the case of a B cell, renal non-Hodgkin lymphoma come to our attention due to urologic symptoms. A review of the literature is provided and it is discussed the differential diagnosis with renal cell carcinoma.

Critical Evaluation of Prostate Carcinoma Imaging

Since accurate clinical staging is the ideal presupposition for any therapeutic decision in prostate cancer (PC), the aim of this paper is to review sensitivity, specificity and accuracy of the imaging techniques routinely used to diagnose and stage PC. They are highly important parameters for selecting patients in whom the disease is confined to the prostate and who may benefit from radical surgery. This is particularly important when considering the high incidence of progression in patients with extracapsular disease or positive surgical margins and that 40–60% of patients with a clinically confined disease have extracapsular involvement shown at the histological examination.

Biological prognostic factors in renal cell carcinoma

– The authors have reviewed literature regarding the main contributions of molecular biology to renal cell carcinoma characterisation. The progress made in the analysis of chromosomal alterations, oncogenes, p53 protein, proliferation indices and adhesion molecules are described. The authors conclude that molecular biology, especially the analysis of chromosomal alterations and proliferation indices, may contribute to renal cell carcinoma diagnosis and to the understanding of its pathogenesis and prognosis.

Biological prognostic factors in renal cell carcinoma: Personal experience

– Histological specimens from 95 RCCs were immunostained for p53 protein, E-cadherin and Ki-67 antigen. Results, as well as stage and grade, were correlated to overall survival and disease-free interval. Markers were also correlated to each other. Statistically significant correlations were observed between stage, grade and Ki-67 versus both overall survival and disease-free interval and between Ki-67 and grade. The authors conclude that the analysis of cell proliferation by Ki-67 immunostaining may help improve understanding of the RCC prognosis.

Raro caso di adenocarcinoma dell'uraco

Urachal carcinoma represents less than 1% of all bladder neoplasms. A case is reported of a 66-year-old man who presented with episodes of macroscopic hematuria. Cystoscopy revealed the presence of a papillar neoplasm between the dome and the right bladder wall. The histological examination showed a “mucinous adenocarcinoma morphologically similar to intestinal neoplasms”. Heteroplasia of the urach was diagnosed following urography, CT and NMR.

Su di un caso di carcinoma a cellule chiare in nefroma cistico multiloculare

A case of adenocarcinoma of the kidney in a multilocular cystic disease is reported. The many diagnostic pitfalls of this rare association are underlined and the diagnostic role of selective renal artery angiography, which removed all doubt about the lesion.

Treatment of abacterial pseudomembranous trigonitis with Nd:YAG laser. Personal experience

— Pseudomembranous trigonitis is a syndrome characterized by urgency, frequency, dysuria, bearing down and dyspareunia, with a typical endoscopic appearance and repeatedly negative urine culture examinations. Cystoscopically it appears as a white patch on the mucosal surface, usually well demarcated and often irregular in shape. The lesion may be finely granular in appearance and extend upward toward the ureteral orifices. Histologically it is a squamous not keratinizing metaplasia. Fifty-four female patients were treated with Nd:YAG laser photocoagulation at our Urologic Department from January 1994 to June 1995. Cystoscopic follow-up showed uniform riepithelization, with linear healing, undoubtedly contributing to the relief of symptoms. In our experience, laser treatment gave good and lasting relief of symptoms like no other therapies; so, high patient compliance, easy technique and good results make Nd:YAG laser photocoagulation highly effective in PMT management.

Laser treatment of bladder cancer

— Many authors have reported safety and efficacy of laser treatment, expecially Nd:YAG Laser, for superficial bladder cancer. The many advantages of this treatment include a presumed smaller recurrence rate, also favoured by better laser ability to achieve a limphatic blockage, and an undoubtedly very small treatment-related mortality. This induces laser photocoagulation to be considered a safe procedure, feasible with a mild anaesthesia and under Day Hospital management. On the other hand the main limits of this procedure are the great difficulties in the histological evaluation of tumoral specimens after laser treatment and poor effectiveness on deep bladder wall infiltrating tumours. A critical analysis of literature data follows and our experience in the laser treatment of superficial bladder tumours.

[Urachal cyst. A case report and review of the literature]

The pathology of urachal disease is rarely seen. This article refers to a case of urachal cyst in a twenty-five-year-old male. In order to discuss the pathogenic, clinical and therapeutic aspects of this rare pathology, it is necessary to carry out a complete revision of the literature. Diagnosis is helped by ultrasound and CT scan of the lower abdomen, while fistulography is necessary when there is cutaneous drainage. The treatment consists of surgical approach which includes complete en-bloc excision of the cyst together with possible urachal residue. Such treatment is indispensable in order to avoid acute infection and/or malignant degeneration, frequent complications which are very serious.

Efficacy of visual laser ablation of the prostate (VLAP) in patients with BPH

From November 1992 to the present, 50 patients, most of whom suffering from severe cardiovascular, respiratory, neurological or hemocoagulative disorders, underwent laser prostatic ablation (VLAP) with Nd:YAG laser. Clinical and uroflowmetric follow-up at 6 weeks, 3 and 6 months showed significant improvement with low morbidity. We believe that VLAP is an alternative to TURP in patients with BPH. A better definition of techniques and overcoming the restrictions due to the learning curve could lead to even better results in the future.

Indici di proliferazione (Ki 67, TLI) ed espressione della p53. Introduzione: Proliferation indices (Ki 67, TLI) and p53 expression. Introduction

Histologic and pathologic findings are the most common and useful prognostic factors in transitional cell cancer of the bladder. Thus, clinicians know their peculiar limits very well. The Authors report the results of a literature review about an oncogenic-derivative protein (p53) and about indices of proliferation Ki 67 and TLI, which are frequently studied in bladder cancer.

Indici di proliferazione (Ki 67, TLI) ed espressione della p53. Esperienza personale: Proliferation indices (Ki 67, TLI) and p53 expression. Personal experience

The Authors report their experience on the study of urothelial bladder cancer by determining the overexpression of p53, DNA-content by flow-cytometry, Ki 67, TLI and cytofluorimetric S-phase in 81 patients. Ki 67, DNA content and p53 overexpression are statistically related with histologic grade, unlike TLI and S-phase. TLI, overexpression of p53 and Ki 67 are statistically related with stage, whereas ploidy and S-phase do not show any relation with stage. The Authors discuss these findings.

[Neoadjuvant chemotherapy in advanced-stage bladder carcinoma. A randomized prospective study comparing MVAC and MVEEC]

The Authors report the results with combination of cisplatin, methotrexate, vinblastine with adriamycin or epidoxorubicin (MVAC v MVEEC), in the neoadjuvant treatment of muscle-infiltrating bladder cancer (T2-4NO-1MO), before cystectomy. MVAC has been used in 29 patients and MVEEC in 25, who met eligibility criteria. Results from this prospective randomised trial show that MVAC and MVEEC can produce clinical and pathologic down-staging in 40-50% of cases: cCR+cPR are 15/28 (54%), pCR+pPR are 11/25 (44%). The survival duration of "pathologic" responders has been significantly longer than that of no responders (median no achieved at 200 weeks v 124 weeks for "pathologic" no responders). We conclude that neoadjuvant chemotherapy with MVAC or MVEEC select the more responsive patients, who have a longer survival.

Association of goserelin and flutamide in the treatment of advanced prostatic carcinoma

From January 1987 to June 1990, 40 previously untreated patients, 60–85 years old (mean 76.7 years) with C and D stage (according to AUS) prostatic adenocarcinoma, were administered analogous LH-RH goserelin and the non-steroid antiandrogen flutamide. The patients were followed until June 1992. 9 patients died from the disease. The treatment was well tolerated in 68% of the cases (27 patients); in the other 13 patients, the administration of flutamide caused secondary effects (gastro-intestinal intolerance, alterations of hepatic function). The administration of goserelin did not cause any secondary effect. The local response (assessed by transrectal echography) was good and in 31 cases consisted of a regression of the initial area from 25 to 50%. The performance status improved in 16 patients. 12 patients had a remission of pain. In all the patients, from the third month of treatment, the testosteronemia remained under 0.8 ng/ml; the prostatic alkaline phosphatase and the prostatic specific antigen presented a good correlation with the clinical evolution of the disease.

Day Hospital and resources utilization: A DRG-analysis of the relationship between costs and benefits

We present the results of our analysis on the operative efficiency of the Day Hospital since it opened on 27/04/92 in the Division of Urology of ULSS 4 Parma. This study has been performed by comparing both median stays in hospital for the numerically more representative surgical operations (prostatectomy, TURP, TURV) and by using the DRG system. The DRG specific cost for every hospitalization has also been calculated. Both systems show an increase in the number of treated cases and a decrease in the average hospitalization. This positive trend has been confirmed by the analysis of the costs.

[Small-cell carcinoma of the bladder: description of a case and review of the literature]

Small-cell carcinoma (also known as oat-cell carcinoma) is a rare tumor that previously concerns the lung; small-cell carcinoma of the bladder is extremely rare (0.5% of all bladder malignancies). The Authors report here the case of a 78th years old man. Fourteen months before our observation he was submitted to a partial cystectomy for a small-cell carcinoma of the bladder cupola. There was no evidence of extra-vesical location at that moment and the patient was not submitted to any adjuvant therapy. At the moment of our observation the disease was very advanced and the patient died in a few time. The Authors discuss about the therapy of bladder small-cell carcinoma in the few cases described by the literature and about the survival of those patients. A radical surgical treatment in association with an adjuvant chemo- or radiotherapy appears as a better way to treat these patients. On account of this case the Authors agree with this choice and conclude that only a combined treatment can allow a better survival.

Trattamento con laser Nd-Yag della schistosomiasi vescicale

We present the case of a young man from Ghana, who complained of dysuria and gross haematuria: he had bladder schistosomiasis. We associated Nd-Yag-laser photocoagulation of residual polipoid lesions with standard pharmacotherapy to obtain a linear cicatrization, without spreading infectious pathological material and with better riepithelialization, to reduce belated obstructive complications, common in this disease. A larger casuistry and longer follow-up are necessary to define the efficacy of this technique.

Antimuscarinic activity of telenzepine on isolated human urinary bladder: no role for M1-muscarinic receptors

1. The antimuscarinic activity of the selective M1-blocking drug, telenzepine, was investigated on the isolated human urinary bladder, contracted with exogenous muscarinic agonists and with field stimulation. 2. Telenzepine (3 x 10(-8)-10(-5) M) concentration-dependently shifted to the right the dose-response curves of bethanechol, acetylcholine and McN-A343, and partially depressed the electrically-evoked twitch responses. 3. pA2 values of telenzepine against bethanechol and McN-A343 were very close. 4. McN-A343 did not modify twitch responses elicited by field stimulation up to 10(-5) M. 5. The lack of muscarinic M1 receptors in human detrusor muscle is confirmed.

A Case of Gonadal Stromal Tumour

Gonadal stromal tumor is a rare neoplasm of the testis. 10% of these tumors are malignant, but malignant histological criteria are not established. The principal therapy is orchidofuniculectomy while lynphadenectomy is for uncertain malignant neoplasm. Radiotherapy and antiblastic therapy sensitivity is poor.

Sternum resection and nephrectomy together in renal carcinoma with solitary sternal metastasis

The role of surgery and adjuvant therapy in renal tumors with metastasis is considered purely palliative. However, in cases of solitary metastasis, an aggressive surgical approach is justified by results reported in current literature, in terms of survival rate and quality of life. In bone metastasis there are additional functional problems related to the site of the lesion and to the extend of the excision. In the reported case, the tumor became evident with a serious compressive cervical-mediastinal simptomatology, due to a solitary sternal metastasis, that was resected along with the primary renal tumor.

Transrectal ultrasound in prostatic malacoplakia: Description of 2 cases

Clinically, it is difficult to distinguish prostatic malacoplakia from carcinoma. Two cases of prostatic malacoplakia are described, highlighting the ultrasound aspects of the lesion.